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Health Related Services Flex Funds Program & New Health Related Social Needs Housing Benefit Overview
CareOregon recognizes the impact of social needs on an individual’s health and wellbeing. We may be able to address social needs that arise by providing social needs assistance to eligible CareOregon members, including housing supports.
Background
Historically, an Oregon Health Plan member accessed housing supports through a provider, such as a primary care provider or a behavioral health provider. Providers, including owners and operators of sober living facilities and sober living houses, were and are authorized to submit requests for housing support on a member’s behalf with their active knowledge and consent.
Through our 1115 Medicaid Waiver, Oregon has increased its ability to provide additional supports to members who are impacted by social determinants of health. The Health Related Social Needs (HRSN) benefit went live in 2024 in Oregon, with the housing benefit becoming available as of November 1, 2024. Health Related Services Flex Funds (HRSF) have been available to coordinated care organizations (CCOs) since 2013.
Current state
As of January 1, 2024, members have the ability to submit their own request for housing supports that may include requests eligible for HRSN or HRSF funding.
These new member-driven housing support requests outnumber and outpace the requests that were once submitted by providers. The “front door” that was built to accommodate member-driven requests doesn’t ask the member to specify which program or benefit they want to apply for; rather, members submit the details of their request, and CareOregon team members vet it to determine which program or benefit that member may be eligible for.
During this time, we have also seen an uptick in cases of fraud, waste, and abuse, a majority of which arise from housing support requests. Our fraud, waste, and abuse teams monitor data and identify trends related to requests or providers.
We continue to support member-driven requests while effectively monitoring for fraud, waste, and abuse. CareOregon’s goal is to process requests, make supports available, and ensure members are not impacted by the internal administration of the programs and benefits they may be eligible for.
Current administration of HRSN and HRSF
| Health Related Social Needs (HRSN) | Health Related Services Flex Funds (HRSF) | |
| Description | The HRSN benefit was developed to provide social support to members who are experiencing certain life transitions, to improve their health during this specific time. | The flex funds program offers non-covered services that are not required, but are intended to improve care delivery and overall member and community health and wellbeing. Flex funds give CCOs an opportunity to address social determinants of health, and must comply with state and federal criteria. |
| How does the process work? | Members may complete a housing support request online. They can also
ask 211 for assistance with completing or submitting a housing support request. CareOregon evaluates all complete request forms based on eligibility criteria. Members will be required to submit documentation on their housing or utility need. Additional documentation may be requested. | A member's provider may submit an HRSF request on their behalf. CareOregon evaluates all completed request forms based on eligibility, how the request matches a member’s treatment plan, and which other community resources or safety net
funds (besides HRS) were pursued before the request was made. Members will be required to submit documentation on their housing or other need, their budget, and their care plan. Additional documentation may be requested. HRSF Standard requests now have a minimum turnaround time of 4+ weeks. HRSF Urgent requests now have a minimum turnaround time of 2+ weeks. |
| Is it a benefit? | Yes, the HRSN benefit is a Medicaid entitlement for those who meet the eligibility criteria | No, the HRSF program is not a Medicaid entitlement |
| What is covered? |
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| Who is eligible? | Eligibility is determined by a qualifying health condition, life transition and/or criteria set by the Oregon Health Authority (OHA). | Eligibility is determined based on the member’s health and treatment plan. It depends on whether the service or item the member wants will help their health, and if it is approved by the HRSF program. The HRSF program is a one-time resource, and not intended to support long-term needs; a plan for long-term sustainability is considered in determining approval of requests. |
More information, including provider resources and applications for both HRSN and HRSF, is available online.
